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Objectives. We have described vaccine coverage of Michigan young adolescents immunized with tetanus, diphtheria, and pertussis; meningococcal conjugate; and human papillomavirus vaccines during 2006-2008. Methods. We obtained data from the Michigan Care Improvement Registry, a state-based immunization information system that included more than 57 million vaccination records. We examined 3 overlapping cohorts of 11- and 12-year-old children (n> 350 000 in each) to assess temporal trends in vaccination coverage, characteristics of those immunized, funding sources, and vaccination sites. Results. Vaccine uptake increased during 2006 through 2008, peaking in the summer months. More than half of children receiving more than 1 vaccine received the vaccines simultaneously. Older age, receipt of Medicaid, and prior completion of early childhood immunizations were associated with greater odds of vaccination. Conclusions. Vaccine coverage among Michigan young adolescents is increasing but continues to be relatively low. Coverage of 11- and 12-year-old children may improve with efforts to encourage vaccination at all health care visits, an increase in public funding in support of adolescent vaccination, and continued monitoring of adolescent vaccination levels through school-based assessments. [ABSTRACT FROM AUTHOR]

This article compares activities of the University of Michigan School of Public Health Public Health Action Support Team (PHAST) to the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Competencies (AECs) to determine the utility of using the competencies to assess extracurricular student training. We mapped the activities from eight PHAST trips occurring from 2006 to 2009 to the 34 AECs for Tier 1 epidemiologists by examining project activities to determine how closely they aligned with the AECs. PHAST trips provided students with opportunities to address 65% of the AECs; 29% of the AECs were addressed by all eight trips. The domains of AECs most often addressed by PHAST trips were leadership and systems thinking, cultural competency, and community dimensions of practice. Mapping PHAST trips to the AECs was useful for all public health students, not just epidemiologists in training. [ABSTRACT FROM AUTHOR]

Objectives. This article maps the program requirements of the University of Michigan preventive medicine residency (PMR) to the newly established Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) to determine the feasibility and utility of using these competencies to assess the training of physician epidemiologists. Methods. The academic and practicum requirements of the PMR are mapped against the 38 AECs for Tier 2, or mid-level epidemiologists. The process of mapping was done by reviewing academic course syllabi/content and practicum tasks to determine how closely they aligned with the AECs. This process allowed us to identify competencies that are relative training strengths and weaknesses of the residency. Results. Overall, the current program requirements of the PMR generally satisfy the AECs, although one competency was not met in either the academic or practicum year, and another was only met in a single, required academic course. The areas in which AECs were fulfilled by many activities in the residency were in domain 1 (assessment and analysis) and domain 2 (basic public health sciences). The areas in which competencies were met by few activities were primarily in domain 6 (financial and operational planning and management) and domain 7 (leadership and systems thinking). Conclusions. We found that the process of mapping an academically rigorous epidemiology training program (the PMR) to the AEC was feasible and useful. It permitted us to identify training strengths and gaps in our program. and consider modifications that will strengthen the level of competency of our physician graduates. [ABSTRACT FROM AUTHOR]

This article reviews the activities of an office of public health practice in a school of public health (SPH) and assesses their impact on master's of public health student training and education. The University of Michigan SPH established a Practice Office in 2005 to develop programs in community-based public health, workforce development, student training, and practice-based research. Student training objectives included increasing practice activity offerings and participation rates, ensuring participant satisfaction with activities, and raising the number of students seeking public health practice employment. According to student survey results from the 2007-2008 and 2008-2009 academic years, the Practice Office achieved mixed success in meeting objectives. Approximately 50% of students participated in at least 1 activity, nearly 50% of students reported that the activities impacted their decision to pursue a practice career, and approximately 75% of students reported moderate to extensive public health practice experience on graduation, compared with 30% at the beginning of their degree program, although this change was not significantly different for those who had participated in Practice Office activities. Initiation of a systematic process to evaluate the impact of practice-based activities early in program development is recommended for all Practice Offices.

Background: Early diagnosis of HIV infection provides the opportunity for treatment to prevent progression to AIDS and for intervention to prevent further transmission. The impact of routine screening of pregnant women and other factors on the stage of HIV disease at diagnosis were evaluated., Methods: Data were collected in 1992-2002 from the medical records of persons presenting for HIV-related care at 2 major medical centers in Detroit, Michigan. Patients were included in the analysis if they had a CD4+ T-cell count recorded within 6 months of their first positive HIV test (N = 1858)., Results: Half of the patients (49%) had a first CD4+ T-cell count of < 200 cells/mm3 and 19% had an AIDS-defining illness at the time of HIV diagnosis. In the multivariate model, pregnant women were less likely than nonpregnant women to enter care with a CD4+ T-cell count of < 200 cells/mm3 (odds ratio, .24; 95% confidence interval, .14-.41). Even after adjusting for pregnancy, female sex was protective, as was age < 30 years. HIV-transmission risk factors, race, and time period of HIV diagnosis were not significantly associated with first CD4+ T-cell counts of < 200 cells/mm3., Conclusion: Routinely offering HIV testing in prenatal care, as required by Michigan law, resulted in earlier diagnoses of HIV in pregnant women, as indicated by their higher CD4+ T-cell counts. Increasing routine HIV testing of all persons seeking medical care may increase the overall proportion of HIV diagnoses that are made early in the disease process.

To examine the effect of highly active antiretroviral therapy (HAART) on the occurrence of primary brain lymphoma (PBL), determine the risk factors for PBL, and assess the difference in survival between individuals who did and did not develop PBL, data were analyzed from the Michigan Adult/Adolescent Spectrum of HIV Disease project (ASD). Among 4,026 HIV-infected individuals enrolled in ASD between January 1990 and December 2000, 64 (1.6%) were diagnosed with PBL. The incidence rate of PBL declined from 5.6 cases per 1000 person-year in the pre-HAART era to 2.1 cases per 1000 person-year in post-HAART era. In the multivariate analysis, individuals whose CD4 count at entry in ASD was either <50 cells/microL (OR: 5.0) or 50-200 cells/microL (OR: 2.3) were significantly more likely to develop PBL than those with a CD4 count >/= 200 cells/microL. PBL was a terminal condition in these patients. The median survival time was consistently shorter among individuals who developed PBL than those who did not, regardless of their CD4 count at entry into ASD.